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MD3002 > treatment of vomiting and gut motility disorders > Flashcards

treatment of vomiting and gut motility disorders Flashcards

1
Q

what two brain units control vomiting

A

vomiting centre

chemoreceptor trigger zone

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2
Q

what are the two main divisions of the medulla oblongata

A

vital centre and non vital centre

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3
Q

where is the vomiting centre

A

lateral reticular formation of the medulla

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4
Q

what stimulates the vomiting centre

A

CTZs

vagal afferents from the gut

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5
Q

where is the CTZ

A

floor of the fourth ventricle (pons/ upper medulla)

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6
Q

describe the stimuli of the CTZ

A

chemical stimuli
site of action of drugs that inhibit or stimulate drugs
stimulated by motion sickness which is stimulated by vestibular apparatus

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7
Q

what are the 3 phases of vomiting

A

nausea + autonomic effects
retching (unproductive)
vomiting- expulsion of gastric contents

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8
Q

what can trigger vomiting

A
  1. Stimulation of sensory nerve endings in stomach & duodenum
  2. Stimulation of vagal sensory endings in pharynx
  3. Drugs or endogenous emetic substances
  4. Disturbances of vestibular apparatus
  5. Stimulation of certain sensory nerves of the heart and viscera
  6. Rise in intracranial pressure
  7. Nauseating smells, repulsive sights, emotional factors
  8. Endocrine factors
  9. Migraine
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9
Q

what are the types of vomiting

A 
Large volumes
Projectile vomiting
Suggestive of gastric outlet or upper GI obstruction
Small amounts
Nausea
Frequent regurgitation of small amounts of gastric contents
Usually psychogenic
Haematemesis
Vomiting fresh or altered blood “coffee-grounds”)
Early-morning
Pregnancy
Alcohol dependence
Metabolic disorders e.g. uraemia
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10
Q

what drug can stimulate vomiting

A

IPECACUANHA, emetine, cephaline

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11
Q

what are the names of histamine receptor antagonists

A 
CINNARAZINE
CYCLIZINE
PROMETHAZINE
DIPHENHYDRAMINE & DIMENHYDRINATE
Marked sedative effects
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12
Q

what are muscarinic receptor antagonist used for

A

motion sickness e.g. hyoscine

can cause drowsiness and dry mouth

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13
Q

what are the names of some phenothiazines

A

CHLORPROMAZINE
PROCHLORPERAZINE
TRIFLUOPERAZINE

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14
Q

what phenothiazines used for

A

CTZ triggered vomiting

act as dopamine antagonist

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15
Q

what is metoclopromide

A

dopamine antagonist

used to treat diabetic gastroparesis and reflux

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16
Q

what are cannabinoids used for

A

decrease nausea associated with cytotoxic drugs

TETRAHYDROCANNIBINOL (THC)
NABILONE

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17
Q

what steroids are used to treat chemo induced emesis

A

dexamethasone

methylprednisolone

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18
Q

what is the name of a 5-hydroxytryptamine antagonist which is a serotonin antagonist used as an anti emetic

A

ondansetron

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19
Q

what is a neuroleptic

A

a substance that depresses nerve activity

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20
Q

what neuroleptics are used to treat emesis (dopamine antagonist)

A

haloperidol
droperidol
domperidone

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21
Q

name some osmotic laxatives

A

saline
magnesium sulphate
hydroxide
lactulose

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22
Q

name some faecal softeners

A

dioctyl sodium sulphosuccinate

liquid paraffin

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23
Q

name some stimulant purgatives

A

castor oil
senna
bisocadyl
sodium picosulphate

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24
Q

what other drugs can be used for gut motility disorders

A

MUSCARINIC AGONISTSANTICHOLINESTERAES
DOMPERIDONE
METOCLOPROMIDE

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25
Q

how can diarrhoea be treated

A

maintain fluid and electrolyte balance
use of an anti-infective agent
inflammatory anti diarrhoeal agents

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26
Q

what opiates can be used as anti motility agents

A

LOPERAMIDE
(MORPHINE)
(CODEINE)

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27
Q

what adsorbants can be used as antimotility agents

A 
Adsorbants
KAOLIN
PECTIN
CHALK
CHARCOAL
METHYL CELLULOSE
ACTIVATED ATTAPULGITE
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28
Q

what drugs can be used to dissolve non calcified cholesterol gallstones

A

CHENODEOXYCHOLIC ACID (CDCA)

URSODEOXYCHOLIC ACID (UDCA)

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29
Q

what painkillers can be used for biliary colic

A

morphine

buprenone or pethidine are better because they do not constrict the sphincter of Oddi

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30
Q

what can be used to relieve biliary spasm

A

atropine

31
Q

what processes are involved in emesis

A

stomach opens
muscle contracts
sphincters need to open

32
Q

where is the fourth ventricle

A

behind the brain stem

this is where the CTZ is

33
Q

where is the vomiting centre

A

lateral reticular formation of the medulla

34
Q

what causes motion sickness

A

vestibular apparatus stimulate the CTZ. a mismatch between the eyes and vestibular apparatus in the ear cannals

35
Q

what is the other part of the brain that can stimulate vomiting

A

higher cortical centres eg in fear,

36
Q

what are some unusual causes of nausea

A

lowered intracranial pressure
infection and inflammation around the heart or viscera
endocrine factors eg dopamine, progesterone and oestrogen

37
Q

what is emetine and cephaline

A

induce vomiting

38
Q

what are diphenhydramine and dimenhydrinate

A

histamine 1 receptor antagonists that are anti emetic and also are sedatives

39
Q

what are histamine antagonists also used for

A

allergies and hayfever

40
Q

what is cinnarazine, cyclizine and promethazine

A

histamine 1 antagonists

41
Q

what is hyoscine

A

motion sickness

drowsiness and dry mouth

42
Q

what do phenothiazines do

A

decrease dopamine in the brain

43
Q

what are phenothiazines also used for

A

anti psychotics
endocrine sickness e.g. morning sickness, radiotherapy, gastroenteritis
dopamine 2 antagonist

44
Q

what is chlopromazine

A

a phenothiazine which is an antiemetic

D2 antagonist which acts in CTZ hence good for chemically induced emesis but not stomach

45
Q

what is prochlorperazine

A

a phenothiazine which is an antiemetic

D2 antagonist which acts in CTZ hence good for chemically induced emesis but not stomach

46
Q

what is trifluoperazine

A

a phenothiazine which is an antiemetic

D2 antagonist which acts in CTZ hence good for chemically induced emesis but not stomach

47
Q

what might be the symptoms of uraemia

A

vomiting and headaches

48
Q

what is metoclopramide

A

dopamine 2 antagonist
also used in schizophrenia
same type of nausea and emesis and phenothiazines

49
Q

what is tetrahydrocannibol (THC)

A

a cannabinoid

50
Q

what is nabilone

A

a synthetic derivative of THC

decreases chemo associated sickness

51
Q

what is dexamethasone and methylprednisone

A 
steroid used in emesis 
reduces intra cranial pressure 
used for severe vomiting 
immunosuppressive
many side effects
52
Q

what is ondansetron

A

serotonin receptor antagonist
for severe and prolonged vomiting

it is a 5HT3 antagonist

53
Q

what is haloperidol

A

neuroleptic dopamine antagonist

54
Q

what is droperidol

A

neuroleptic dopamine antagonist

55
Q

what is domperidone

A

neuroleptic dopamine antagonist

56
Q

what is a side effect of opiates

A

decreased gut motility

57
Q

what are methyl cellulose, stercula, agar, bran and ispaghula husk

A

bulk laxatives

not digested

58
Q

what is saline, magnesium sulphate, hydroxide, lactulose

A

osmotic laxatives

they retain water and trigger peristalsis

59
Q

what is dioctyl sodium sulphosuccinate and liquid paraffin

A

faecal softeners

break up faeces

60
Q

what is castor oil, senna, bisocadyl and sodium picosulphate

A

stimulant purgatives
tiggers bowel evacuation
acts when it is in the stomach

61
Q

what is the problem with muscarinic agonists and anticholinesterases

A

toxic

62
Q

what are these drugs: muscarinic agonists, anticholinesterases, domperidone, metoclopromide

A

speeds up the passage of food through the stomach and into the intestine
helps with paralysis

63
Q

what is loperamide

A

Antimotility agent opiate

64
Q

what is kaolin, pectin, chalk, charcoal, etc

A

antimotility adsorbants used in diarrhoea

65
Q

what is cholelithiasis

A

gall stones

66
Q

what is chenodeoxycholic acid

A

used to dissolve non calcified cholesterol gallstones

67
Q

what is ursodeoxycholic acid

A

used to dissolve non calcified cholesterol gallstones

68
Q

what is buprenone and pethidine

A

morphine like pain killer

69
Q

what is atropine

A

used to relieve billary spasm

70
Q

what are neuroleptics

A

sedatives
antipsychotics
dopamine antagonist

71
Q

what is uraemia

A

urine in blood causes vomiting

72
Q

what are phenothiazines used for apart from CTZ vomiting

A

antipsychotic in larger doses

D2 antagonist

73
Q

metochlopramide

A

schistophrenia and CTZ emesis and gut motility

MD3002 (56 decks)

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